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Sandy Oeverman, CTRS, ResCare Premier Page 1 of 3
While studying to be a therapeutic recreation specialist in college, I worked as a lifeguard and swim instructor at a small, warm-water local pool, where many seniors came to swim and socialize. It was during that time that I first became interested in the idea of using aquatics as a therapeutic modality.
During the senior swim time, I regularly observed an elderly gentleman hobbling in slowly with his cane at his side. His posture was bent and his slow, difficult movements told of his pain with each arthritic step. Once he made his descent into the warm water, his posture relaxed and his movements became visibly smoother and less painful. He spent the next half hour leisurely stretching, paddling about, and socializing with the other pool patrons. When the old man exited the pool, he looked like a younger, more limber version of himself. However, the most marked improvement in his appearance was his attitude. The man always smiled and bid me a fond farewell after each session in the pool. This experience piqued my interest in the use of aquatics as a tool for rehabilitation, as well as a viable exercise option for people with disabilities who are unable to exercise safely on land.
People with disabilities are often caught in a cycle of pain, depression, and stress. Disability can lead to social isolation, an external locus of control (believing that one does not have choice or possess control of one’s destiny), and the belief that exercise and fitness is impossible for them. Aquatic therapy is able to break this chronic pain cycle largely because of the unique properties of water.
How Does it Work?
Individuals with traumatic brain injury (TBI) or other special populations may be unable to exercise on land, but often can do so comfortably in the water. The buoyancy of water causes the individual to feel an upward thrust when submerged. This force acts in the opposite direction of gravity. Buoyancy allows for a variety of exercises to be performed in the pool with minimal equipment. In addition, people with balance deficits may experience less fear of falling while walking and exercising in the pool.
Exercises performed in water can be adapted to resist the upward thrust of buoyancy, support the upward thrust of buoyancy, or to assist this upward thrust. Submersion decreases weight bearing by up to 90% when submerged in neck deep water, so an individual who is unable to support their body weight on land is often able to walk with minimal support in the pool. Other benefits of buoyancy are that the water supports weak muscles, enhances flexibility and range of motion, and increases the ease of handling for the therapist.
Hydrostatic pressure is a wonderful benefit of aquatic therapy. Hydrostatic pressure is the force exerted on the immersed body by fluid molecules. No movement is necessary by the individual in order to reap the many benefits of hydrostatic pressure. I use this phenomenon as a motivational tool for my clients. I might say, “Let’s just get in the water today and let the water do its work.” This is often enough to get someone motivated enough to try the pool.
Hydrostatic pressure decreases pain and edema, which in turn increases range of motion. It also increases venous return and circulation by assisting the heart and decreasing blood pooling in extremities. Hydrostatic pressure turns down the body’s reticular (activating) system (the brain’s system of arousal), dampening tactile sensory input to the brain. This is partly why the water is such a calming environment for most people. Individuals who are tactilely defensive (having a negative response to touch) are often able to tune out their surroundings and focus on and enjoy being in the pool.
The benefit of being submerged in the water is that the individual experiences equal pressure everywhere. Healthy individuals will probably not even notice this slight “squeezing in” feeling, which is similar to the effects of wearing compression stockings. However, an unhealthy person may notice the squeezing sensation, and it may cause some anxiety. In such cases, gentle encouragement and conversation to redirect attention may be helpful. Submersion also places increased demands on the respiratory system, allowing for increased exhalation. Therefore, the respiratory muscles are forced to work a bit harder in the water, which causes these muscles to become more toned even without movement in the water.
Practitioners should also be aware of the complications that water can pose in therapy or exercise. Buoyancy might cause stability problems both for the practitioner and for the individual. However, this buoyancy can provide individuals with an excellent core stability workout (building the trunk musculature to control the position of the lumbar spine). In addition, buoyancy can make it difficult for individuals to get balanced in the water because flaccid, weak extremities may float and spastic, flexed extremities may sink. An individual in the supine position will tend to roll toward the spastic or “heavy” side. Flotation supports, such as: “water noodles,” lifejackets, or specially designed aquatic floatation devices can help compensate for stability problems. The practitioner should also be careful to watch that the individual remains in a neutral spine position when submerged.
Another consideration that the practitioner should keep in mind is that the experience of wearing a bathing suit in a public place, especially for those with physical disabilities, can be a very sensitive issue. Changing before and after the pool session usually requires extra time as well. Compassion, patience, and a sense of humor can go a long way in a potentially uncomfortable or embarrassing situation.
The therapist should also keep in mind that most people with special needs should enter and exit the water very slowly. This will help the individual adjust to the temperature and pressure of the water, as well as ease anxiety for those who are apprehensive. Individuals with visual impairments should be completely oriented to the pool at the beginning of each session. Assist them in walking around the pool perimeter with a hand on the pool’s edge. Point out landmarks, such as a lifeguard chair and pool ladder. Remember that each day a person may have varying degrees of comfort in the pool.
From ResCare Premier. Used with permission. Third-party use prohibited. www.rescarepremiertexas.com.
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